Healthcare Provider Details

I. General information

NPI: 1013924224
Provider Name (Legal Business Name): SARA ELIZABETH BRAINERD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/09/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 LEBANON STREET
LEBANON IN
46052-3076
US

IV. Provider business mailing address

1310 S LEBANON ST
LEBANON IN
46052-3076
US

V. Phone/Fax

Practice location:
  • Phone: 765-482-7005
  • Fax: 765-483-2517
Mailing address:
  • Phone: 765-482-7005
  • Fax: 765-483-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG06210272
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: